Outpatient Palliative Care Needs of Metastatic Cancer Patients Treated With Radiation Therapy

22 Background: A key setting for the provision of palliative care is the emergency department (ED) where important decisions regarding treatment and next site of care are determined; however identifying patients who would benefit from a palliative care consult is an ongoing challenge. The (SPEED) is a 5-question tool that assesses unmet palliative care needs. Methods: We performed a retrospective derivation and temporal validation of a risk model for a palliative care event (PCE) among cancer patients with an ED visit and subsequent hospital admission using data available upon arrival, including data from the SPEED tool. A PCE was defined as a palliative care consult, discharge to hospice, or in-hospital death. We developed a multivariate logistic regression model to predict PCEs. We assessed model performance using a receiver operating characteristic curve and visual inspection of quintile plots. Results: Eleven factors were identified as predictive of a PCE, including SPEED score, proxy SPEED informer, age, EMS arrival, emergent or immediate ED acuity, the number of ED visits within the last 90 days, metastatic cancer, cardiac arrhythmias, coagulopathy, depression and weight loss. In validation, the risk model had an area under the curve of 0.72 and calibration showed an underestimation of risk in the second and third quintiles. Conclusions: A risk model based on SPEED score has been successfully derived, but needs a larger dataset for proper validation. If the predictive ability of the model is confirmed, a risk model can efficiently identify cancer patients arriving to the ED who may benefit from early initiation of a palliative care consult.

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Palliative Referrals in Advanced Cancer Patients: Utilizing the Supportive and Palliative Care Indicators Tool and Rothman Index

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211017873 ◽

2021 ◽

pp. 104990912110178

Author(s):

Abigail Sy Chan ◽

Amit Rout ◽

Christopher R. D.’Adamo ◽

Irina Lev ◽

Amy Yu ◽

...

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Length Of Hospital Stay ◽

Inpatient Setting ◽

Advanced Cancer Patients ◽

Care Needs ◽

Early Palliative Care ◽

Code Status ◽

Palliative Care Needs

Background: Timely identification of palliative care needs can reduce hospitalizations and improve quality of life. The Supportive & Palliative Care Indicators Tool (SPICT) identifies patients with advanced medical conditions who may need special care planning. The Rothman Index (RI) detects patients at high risk of acutely decompensating in the inpatient setting. SPICT and RI among cancer patients were utilized in this study to evaluate their potential roles in palliative care referrals. Methods: Advanced cancer patients admitted to an institution in Baltimore, Maryland in 2019 were retrospectively reviewed. Patient demographics, length of hospital stay (LOS), palliative care referrals, RI scores, and SPICT scores were obtained. Patients were divided into SPICT positive or negative and RI > 60 or RI < 60.Unpaired t-tests and chi-square tests were utilized to determine the associations between SPICT and RI and early palliative care needs and mortality. Results: 227 patients were included, with a mean age of 68 years, 63% Black, 59% female, with the majority having lung and GI malignancies. Sixty percent were SPICT +, 21% had RI < 60. SPICT + patients were more likely to have RI < 60 (p = 0.001). SPICT + and RI < 60 patients were more likely to have longer LOS, change in code status, more palliative/hospice referrals, and increased mortality (p <0.05). Conclusions: SPICT and RI are valuable tools in predicting mortality and palliative/hospice care referrals. These can also be utilized to initiate early palliative and goals of care discussions in patients with advanced cancer.

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Palliative Care Needs of Advanced Cancer Patients in the Emergency Department (S767)

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2017.12.421 ◽

2018 ◽

Vol 55 (2) ◽

pp. 693

Author(s):

Isabelle Marcelin ◽

Caroline McNaughton ◽

Nicole Tang ◽

Jeffrey Caterino ◽

Corita Grudzen

Keyword(s):

Emergency Department ◽

Palliative Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Advanced Cancer Patients ◽

Care Needs ◽

Palliative Care Needs

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‘They patiently heard what we had to say…this felt different to me’: the palliative care needs and care experiences of advanced cancer patients and their families in Bangladesh

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2011-000143 ◽

2012 ◽

Vol 2 (2) ◽

pp. 145-149 ◽

Cited By ~ 6

Author(s):

Rogieh Dehghan ◽

Jairam Ramakrishnan ◽

Nezzan Uddin-Ahmed ◽

Richard Harding

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Advanced Cancer Patients ◽

Care Needs ◽

Palliative Care Needs

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Palliative referrals in advanced cancer patients: Utilizing the Supportive and Palliative Care Indicators Tool and Rothman Index.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.12102 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 12102-12102

Author(s):

Abigail Sy Chan ◽

Amit Rout ◽

Irina Lev ◽

Amy Yu ◽

Chris D'Adamo ◽

...

Keyword(s):

Palliative Care ◽

Hospital Stay ◽

Cancer Patients ◽

Advanced Cancer ◽

Hospice Care ◽

Inpatient Setting ◽

Care Needs ◽

Clinical Indicators ◽

Code Status ◽

Palliative Care Needs

12102 Backgroun1d: Timely identification of palliative care needs have the ability to reduce hospitalizations and improve QOL. The Supportive & Palliative Care Indicators Tool (SPICT) is used to identify patients with advanced stage medical conditions who may need special care planning. The Rothman Index (RI) detects patients at high risk of acutely decompensating in the inpatient setting and has been validated to assess 24-hour mortality risk. We used SPICT and RI in cancer patients admitted to the hospital and evaluated their roles in recognizing early palliative care needs and 6-month mortality. Methods: Advanced/metastatic cancer patients admitted to our institution from Jan 1, 2019 to June 30, 2019 were retrospectively reviewed. Patient demographics, length of hospital stay (LOS), comorbidities, palliative/hospice care referrals, vital status, initial RI score, and computed SPICT scores were obtained. Worse clinical indicators were defined as SPICT positive if it met > 2 clinical indicators or RI < 60. Univariate and bivariate analyses were performed. Results: A total of 227 patients were included, mean age 68, 34% Caucasians, 63% Blacks, 59% female, median comorbidities of 3, with majority having lung and GI malignancies. A total of 137 (60%) were SPICT +, 47 (21%) had RI < 60, and 38 (17%) concurrent SPICT + and RI < 60. SPICT + patients were more likely to have longer hospital stay, change in code status, more palliative/hospice referrals, and increased mortality. Those with RI < 60 had similar results (Table). SPICT + patients are more likely to have RI < 60 (p = 0.0013). Conclusions: SPICT and RI are valuable tools in predicting 6-month mortality and palliative/hospice care referrals. These can also be utilized to initiate early palliative and goals of care discussions in patients with advanced cancer. [Table: see text]

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Early proactive referral identifies lung cancer patients with significant palliative care needs

Lung Cancer ◽

10.1016/s0169-5002(19)30253-3 ◽

2019 ◽

Vol 127 ◽

pp. S87

Author(s):

J. Droney ◽

Y. Kano ◽

J. Nevin ◽

L. Kamal ◽

A. Kennett ◽

...

Keyword(s):

Lung Cancer ◽

Palliative Care ◽

Cancer Patients ◽

Care Needs ◽

Lung Cancer Patients ◽

Palliative Care Needs

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Influence of palliative care consult on radiation therapy utilization for metastatic cancer patients within the last six months.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.149 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 149-149

Author(s):

Jessica Moore Schuster ◽

Karman Tam ◽

Nevena Skoro ◽

Brian Cassel ◽

Mitchell Steven Anscher ◽

...

Keyword(s):

Palliative Care ◽

Radiation Therapy ◽

Cancer Patients ◽

Cost Reduction ◽

Metastatic Cancer ◽

Inpatient Setting ◽

Terminally Ill Cancer Patients ◽

Death Data ◽

Hospital Contact ◽

Significant Factors

149 Background: Palliative care encounters (PCE) have been demonstrated to reduce resource utilization and costs within an inpatient setting. Little is known about influence PCE on delivery of radiation therapy (RT). We hypothesize that terminally ill cancer patients completing PCE would have increased utilization of palliative RT (PRT) with decreased fractions and overall costs. Methods: Retrospective review of 3,128 cancer patients that had at least one hospital contact within 6 months prior to death. Data from single academic institution decedent database, hospital billing claims, and radiation oncology electronic medical record (RO EMR) was combined into one database that could be queried. Results: From January 2009 to June 2011, 417 patients with soft tissue/bone/not other specified (NOS) excluding brain metastatic disease and at least one palliative contact within 6 months prior to death were identified. Palliative contact: PRT or palliative care consult or admission (PCE). 232 patients completed 321 RT courses (87% palliative, 8% curative, and 5% unknown). 18% of PRT was delivered in 1 fraction, 30% in 2-5, 4% in 6-9, 36% in 10, and 12% > 10 fractions. PRT and PCE were both completed in 48% (33% before, 13% during and 54% after delivery of RT). PCE prior to PRT vs. PCE none/during/after PRT were more likely to result in 5 or fewer PRT treatments (62% vs. 40%, p=0.0309) and there was a trend for increased delivery of single fraction PRT (18 vs. 15%). Based on timing of PCE, no increase in PRT courses per patient and no overall cost reduction was observed beyond direct cost reduction by reducing PRT fractions. Other non-significant factors included sex, race, and payer type. Majority of PCE were within 30 days prior to death 52% vs. only 44% of PRT. Conclusions: Relationship between PCE and PRT is complex and are likely compounded by factors not accounted for in this study. Despite these limitations, PCE prior to delivery of PRT correlates to reduced treatment numbers. This report highlights that overall referrals for palliative services could be integrated into comprehensive cancer much earlier and in a more multi-disciplinary way.

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Outpatient palliative care needs of metastatic cancer patients treated with radiation therapy.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.29_suppl.73 ◽

2015 ◽

Vol 33 (29_suppl) ◽

pp. 73-73

Author(s):

Shayna Eliana Rich ◽

Jacqueline Castagno ◽

Rebecca Beaulieu ◽

Anamaria R Yeung

Keyword(s):

Palliative Care ◽

Radiation Therapy ◽

Radiation Treatment ◽

Metastatic Cancer ◽

Stage Iv ◽

Patient Treatment ◽

Care Needs ◽

Symptom Scale ◽

Palliative Intent ◽

Palliative Care Outcome Scale

73 Background: It is unclear how frequently patients with metastatic cancer treated with radiation therapy have unmet physical, psychological, spiritual, and practical needs of patients. This study aims to determine the level of support needed to meet this burden. Methods: We performed a telephone survey to evaluate the unmet needs of living patients with stage IV metastatic cancer treated with radiation therapy at a single institution in the priot six months. Data were collected using the Palliative care Outcome Scale, a validated 12-question survey about unmet patient needs, and its associated symptom scale. We examined patient treatment history by reviewing medical records. Among 87 eligible patients treated, 45 had died, 19 could not be reached, and two declined participation. Thus, 21 patients were included in the analysis. Results: Most frequent diagnoses were lung (24%; 5/21) or colorectal cancer (19%; 4/21). Most patients’ recent radiation course had palliative intent (62%; 13/21), but eight had received ablative radiation. No patients were undergoing radiation treatment when the survey was administered, and 57% (12/21) were receiving chemotherapy. Despite most patients seeing a physician within 2 weeks of the survey (median 1.7 weeks; range 0-11.4 weeks), most patients reported pain (67%) and anxiety (57%), and about 50% reported these issues as moderate or worse. At least one-third of patients reported having each need unmet. Patients complained of a median of five symptoms, with 57% of patients reporting any symptom severe. Patients on chemotherapy (n = 12) reported more symptoms and increased symptom severity, but 44% of patients reported moderate pain even among those not undergoing any therapy. Conclusions: Patients with metastatic cancer recently treated with radiation therapy continue to have substantial needs that are often not being met by standard oncologic care, despite recent visits with physicians. Although many of these patients are receiving chemotherapy and may be identified for palliative care programs through the medical oncology service, radiation oncology clinics should also routinely integrate quality palliative care for patients with metastatic cancer.

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Differences in palliative care needs among cancer survivors in an inner city academic facility versus a suburban community facility.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.29_suppl.61 ◽

2015 ◽

Vol 33 (29_suppl) ◽

pp. 61-61

Author(s):

Alison Lutz ◽

Rachel Regn ◽

William Robinson ◽

William R. Robinson

Keyword(s):

Palliative Care ◽

Child Care ◽

Inner City ◽

Cancer Patients ◽

Private Insurance ◽

Care Needs ◽

Early Access ◽

Community Facility ◽

Suburban Community ◽

Palliative Care Needs

61 Background: To determine differences in palliative care (PC) needs in newly diagnosed cancer patients from an inner-city academic facility compared to a suburban, community facility. Also, to identify ways to improve PC for cancer patients in these locations. Methods: 270 subjects with cancer were prospectively identified, 85 from an inner city academic facility (Site A), and 185 from a suburban community facility in the same metropolitan area. (Site B) All patients received treatment from board-certified oncologists. Master’s level Social Workers asked all subjects to complete a standardized, validated questionnaire to determine their palliative care needs prior to treatment. Completed questionnaires were collected and data was depersonalized and analyzed by the authors. Statistical differences were assessed using standard methods. Results: Site A patients were younger (56.3 vs 61.5years) less likely to be caucasian (35/85, 41.2% vs 114/185, 61.6%) and less likely to have private insurance (28/85, 32.9% vs 187/185, 47%). Site B patients were more likely to express a fear of pain, (112/185, 60.5% vs 28/85,32.9%) dying, (112/185, 60.5% vs 18/85, 21.2%) being alone, (112/185(60.5% vs 15/85, 17.7%) or nausea (117/185, 63.2% vs 10/85, 11.8%). Site A patients were more likely to express fear of not having transportation, (35/85, 41.2% vs 42/185, 22.1%) inability to pay for prescriptions, (28/85, 32.9% vs 40/185, 21.6%) or child care (13/85, 15.3% vs 9/185, 4.9%). All differences were significant at a p < 0.05. Conclusions: There are major differences in the PC needs of patients presenting to an inner-city academic vs suburban community facility. To be most effective, PC programs must be tailored to the community. Interventions proposed for the suburban community facility include early access to: 1) grief counseling, 2) support groups, 3) Nurse-Navigators. Interventions proposed for the inner city academic facility include early access to: 1) Medication cost assistance programs (local philanthropies, facility-based pharmacy discounts) 2) travel services (cab vouchers, coordination with public transportation schedules) 3) on-site child care facilities.

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